Preparing nurses for primary health care reforms

Momentum is growing for a nationally driven and funded, integrated primary care service system in Australia. The Federal government has a clear focus on reforming the health system to strengthen prevention and facilitate care at the primary level. Furthermore, there is growing awareness that quality indicators and measures for optimising care for the population, need to part of future reforms. Primary and community care nurses are, as part of an integrated team, in an ideal position to play a key role in the delivery of primary care services as long as they are adequately prepared. Future policy development on the practice nurse role needs to be evidence based and work towards nationally consistent standards for an education framework and career pathways for nurses in primary care, and the development of inter-professional primary care teams. The nurses’ role should be supported by funding mechanisms that support the delivery of quality outcomes in primary care.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

A tool to evaluate patients' experience of nursing care in Australian general practice: Development of the Patient Enablement and Satisfaction Survey (PESS)

Australian health policy initiatives have increasingly supported the employment of nurses in general practice. An understanding of the impact of nursing care on patients in this setting is integral to assuring quality, safety and a patient-centred focus

Development and implementation of a nurse-led walk-in centre: evidence lost in translation?

Objectives: The design of the first Australian public nurse-led primary care walk-in centre was modelled on those established in the English National Health Service (NHS). An independent evaluation of the first 12 months of operation of the Australian Ca

Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity:

Nurses in primary health care (PHC) provide an increasing proportion of chronic disease management and preventive lifestyle advice. The databases MEDLINE, CINAHL, EMBASE and PsychINFO were searched and the articles were systematically reviewed for articles describing controlled adult lifestyle intervention studies delivered by a PHC nurse, in a PHC setting. Thirty-one articles describing 28 studies were analysed by comparison group which revealed: (i) no difference of effect when the same intervention was delivered by a PHC nurse compared to other health professionals in PHC (n = 2); (ii) the provision of counselling delivered by a PHC nurse was more effective than health screening (n = 10); (iii) counselling based on behaviour change theory was more effective than the same dose of non-behavioural counselling when at least three counselling sessions were delivered (n = 3). The evidence supports the effectiveness of lifestyle interventions delivered by nurses in PHC to affect positive changes on outcomes associated with the prevention of chronic disease including: weight, blood pressure, cholesterol, dietary and physical activity behaviours, patient satisfaction, readiness for change and quality of life. The strength of recommendations is limited by the small number of studies within each comparison group and the high risk of bias of the majority of studies

Nursing in Primary Health Care: maximising the nursing role

APHCRI Conversations was a regular program of presentations held at the Department of Health to facilitate exchange between APHCRI Network researchers and Department policymakers. Topics are developed jointly with the Department of Health and involve a range of speakers from APHCRI, including CRE invited experts, CRE Chief Investigators and stream project Chief Investigator

Stakeholder perceptions of a nurse led walk-in centre

BACKGROUND As many countries face primary care medical workforce shortages and find it difficult to provide timely and affordable care they seek to find new ways of delivering first point of contact health care through developing new service models. In common with other areas of rural and regional Australia, the Australian Capital Territory (ACT) is currently experiencing a general practitioner (GP) workforce shortage which impacts significantly on the ability of patients to access GP led primary care services. The introduction of a nurse led primary care Walk-in Centre in the ACT aimed to fulfill an unmet health care need in the community and meet projected demand for health care services as well as relieve pressure on the hospital system. Stakeholders have the potential to influence health service planning and policy, to advise on the potential of services to meet population health needs and to assess how acceptable health service innovation is to key stakeholder groups. This study aimed to ascertain the views of key stakeholders about the Walk-in Centre. METHODS Stakeholders were purposively selected through the identification of individuals and organisations which had organisational or professional contact with the Walk-in Centre. Semi structured interviews around key themes were conducted with seventeen stakeholders. RESULTS Stakeholders were generally supportive of the Walk-in Centre but identified key areas which they considered needed to be addressed. These included the service's systems, full utilisation of the nurse practitioner role and adequate education and training. It was also suggested that a doctor could be available to the Centre as a source of referral for patients who fall outside the nurses' scope of practice. The location of the Centre was seen to impact on patient flows to the Emergency Department. CONCLUSION Nurse led Walk-in Centres are one response to addressing primary health care medical workforce shortages. Whilst some stakeholders have reservations about the model others are supportive and see the potential the model has to provide accessible primary health care. Any further developments of nurse-led Walk-in Centres need to take into account the views of key stakeholders so as to ensure that the model is acceptable and sustainable.This study was funded by Australian Capital Territory (ACT) Health

Knowledge brokerage and research utilisation: a discussion document prepared for the Australian Government Department of Health and Ageing

In mid 2009 the Australian Department of Health and Ageing (DoHA) funded the Australian Primary Health Care Research Institute (APHCRI) to undertake a project on Knowledge Brokerage (KB). The aim of the project was to develop a model through which APHCRI, DoHA and other key stakeholders could work together over the next iteration of APHCRI’s contract for translating research evidence into Australian primary health care systems and services. The KB model would support the Commonwealth’s health reform agenda through facilitating the dissemination of research findings to policy makers and enabling policy makers to pose research questions addressing their need for evidence to support policy development. The KB project undertaken by APHCRI has three components;  A comprehensive literature review  A workshop of key stakeholders to identify different models of KB, work towards identifying the key components of successful models and to devise a framework to support effective knowledge translation  A review of the processes used by APHCRI to fund research and the effectiveness of the synthesis and transfer of knowledge generated by APHCRI-funded research to date. This document reports on the outcomes of these three components and offers recommendations for future action.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Take the sex out of STI screening! Views of young women on implementing chlamydia screening in General Practice

<p>Abstract</p> <p>Background</p> <p>Australia is developing a chlamydia screening program. This study aimed to determine the attitudes of young women to the introduction of chlamydia screening in Australian General Practice.</p> <p>Methods</p> <p>In-depth face-to-face interviews with 24 young women from across Victoria, Australia, attending a randomly selected sample of general practices.</p> <p>Results</p> <p>Young women reported that they would accept age-based screening for chlamydia in general practice, during both sexual-health and non-sexual-health related consultations. Trust in their general practitioner (GP) was reported to be a major factor in the acceptability of chlamydia screening. The women felt chlamydia screening should be offered to <it>all </it>young women rather than targeted at "high risk" women based on sexual history and they particularly emphasised the importance of normalising chlamydia screening. The women reported that they did not want to be asked to provide a sexual history as part of being asked to have a chlamydia test. Some reported that they would lie if asked how many partners they had had</p> <p>Conclusion</p> <p>Women do not want a sexual history taken when being asked to have a chlamydia test while attending a general practitioner. They prefer the offer of chlamydia screening to be based on age rather than assessment of sexual risk. Chlamydia screening needs to be normalised and destigmatised.</p

Patient initiated aggression and violence in the Australian general practice setting

This is the first national study to be conducted in Australia examining the incidence and prevalence of violence against general practitioners and general practice staff.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

What needs to change to increase chlamydia screening in general practice in Australia? The views of general practitioners

<p>Abstract</p> <p>Background</p> <p>Australia is considering implementing a chlamydia screening program in general practice. The views of general practitioners (GPs) are necessary to inform the design of the program. This paper aimed to investigate Australian GPs' views on how chlamydia screening could work in the Australian context.</p> <p>Methods</p> <p>This project used both qualitative interviews and a quantitative questionnaire. GPs were randomly selected from a national database of medical practitioners for both the qualitative and quantitative components. Semi-structured interviews were conducted with GPs and a thematic analysis conducted. The results of the interviews were used to design a quantitative postal questionnaire for completion by a larger sample of GPs. Up to three reminders were sent to non-responders.</p> <p>Results</p> <p>Twenty one GPs completed an interview and 255 completed the postal questionnaire. The results of the postal survey were in strong concordance with those of the interview. GPs identified a number of barriers to increased screening including lack of time, knowledge of GPs and the public about chlamydia, patient embarrassment and support for partner notification. GPs felt strongly that screening would be easier if there was a national program and if the public and GPs had a greater knowledge about chlamydia. Incentive payments and mechanisms for recall and reminders would facilitate screening. Greater support for contact tracing would be important if screening is to increase.</p> <p>Conclusion</p> <p>Chlamydia screening in general practice is acceptable to Australian GPs. If screening is to succeed, policy makers must consider the facilitators identified by GPs.</p